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Agenda Item 23

Minutes of the KCHS BOARD (KCHSB) held on 25 March 2011 at 8:30pm – 12:00pm in Meeting Room 3 Beckside Court Present:

Suzy Brain England OBE, (Chair) (SBE) Robert Flack, Managing Director (RF) Patricia Drake - Non-Executive Director (PD) Tina Quinn, Clinical and Operations Lead of KCHS (TQ) Janice Boucher – Finance and Performance Lead (JB) Gwen Ruddlesdin – Head of Integrated Governance (GR) Laura Campbell - Assistant Director of Workforce, Commissioning & Policy (LC) Jim Barwick – Transformational Lead (JPB)

In attendance:

Lyn Barker - Minute Taker (LB)

Agenda Item 14

Apologies for Absence Munir Ahmed - Non-Executive Director (MA)

Agenda Item15

Declaration of Interest Declarations of Interests are recorded and held with the KCHS Board Secretary. Laura Campbell works for NHS Kirklees as well as KCHS. Pat Drake is a Director of The Yorkshire Ambulance Service

Agenda Item16

Minutes of The Previous Meeting The minutes of the Kirklees CHS Board meeting held 25 February 2011 were agreed as a true and accurate record. The minutes were signed by the Chair.

Agenda Item 17

Matters Arising from 25 February 2011 There were no matters arising.

Agenda Item 18

Managing Directors’ Report RF updated the KCHS Board with a PowerPoint presentation highlighting the following: Re-ablement monies Confusion of use of the money in the system now and in the future A Panel is now in place Intension to use money with LA to strengthen admission avoidance efforts and ensure appropriate levels of Therapies in Intermediate Care 1

Re-ablement money comes from the Government to help people discharge from hospital more quickly. The money will be used in 3 areas: 1. This work needs to have links with the new national 111 number to be commissioned. There will also be links with the SPA. ACTION 1 – JPB to invite Pat Andrewartha to the KCHS Board meeting about the 111 number. Pat Drake declared that she is a Director of the Yorkshire Ambulance Service. 2. Process in A&E 3. Better management in care homes. This will make the pathway from hospital better. Working with GP’s to be more proactive to work with people in care homes. This is work in progress in financial steam 2011/12. Work with CHFT Simulation exercise to look at process of admission avoidance and speedier discharge Agreed improve communication and community staff can have more rapid access to consultant opinion Actions in place with regular review process Local Authority integration Work with LA to map integration undertaken on 17.3.2011 Project plan is now being put in place Political hurdles that need to be crossed taken into cabinet and mixed feelings were shown Services to be transferred are now much better understood timescales still to be agreed JPB explained to the KCHS Board that there is more work to be done to ensure smooth transition for the Local Authority. The KCHS Board queried if there is risk to KCHS putting KCHS under pressure to meet the LA’s time frame. RF assured the KCHS Board that this can be done in KCHS’ own time frame. The LA is responsible for all services in the care homes; the asset in buildings will remain with the LA but will give KCHS 80 beds. KCHS already provides intermediate care in two care homes. 120 staff will be TUPED across. The challenge will be skill mix and issues about residents in the homes. This is for information and more detailed plans will come to the KCHS Board at a later stage. Road shows 2

Roadshows still being held for groups of staff with a good turn out and some good discussions Interest in council of members and branding discussion Process in place to ensure greater involvement in the values, brand and personality debate The staff has been positive about branding but we need to get the message out to staff who have not attended road shows. LC and AT are doing proformas and sending out to staff even if they did not attend any of the road shows. People moves Jim Barwick has joined us as Transformational Lead Mike Potts is confirmed as the CEO of the cluster Bryan Machin is moving to Leeds Community Healthcare Trust to the role of FD on 30 April 2011 concerns were raised about getting KCHS finance sorted out before he goes. Agenda Item 19

Finance and Performance Lead’s Report Janice reported the underlying full year forecast position favourable by £1.0m, enabling the non recurrent costs of £0.4m for Organisation form to be funded within budget. There are concerns that DN efficiency project and travel savings falling behind target leading to financial risks for 2011/12. 2011/12 budget unlikely to be complete by April – proposed action plan to mitigate the risk in section 4. Contracted headcount at 866 WTE is 73 WTE lower than funded, and paid headcount at 883 WTE is 56 WTE lower than funded. There are 50WTE approved vacancies currently in the process not yet recruited. On recruitment, headcount will be 916, higher than IBP opening position of 906. Further work is required to understand the vacancies approved and reason for delays. In addition we need to manage down the approved vacancies back in line with the IBP start position SEIF Phase 2 funding has been approved, but not yet received ACTION 2 – JB to complete risk analysis of vacancies ACTION 3 - JB revamp of vacancy control process JB informed the KCHS Board that the Vacancies are not filling fast enough SLT is a typical example, not filling vacancies as there are not enough people out in the market that are trained. Training for staff to become specialists but this takes time. The experts are short so causing pressures.


ACTION 4 – JB/ LC to understand the vacancies and make sure there is no mismatch ACTION 5 – TQ/LC to look at skill mix The Year to Date favourable position comprises the following key variances: (£926k) headcount/pay savings £30k CQC registration £75k District Nurse Messaging Services for 09/10 and 10/11 £71k QOF costs £95k Continence Products £290kToughbooks revenue costs (inc £40k 09/10,£35k chargers) £68k Broughton House Locum (£118k) Dental income (£124k) CASH staffing and drugs (£55k) Interpreters (£85k) SEIF funding £125k DN Medical Equipment £12k Other (£542k) Total YTD favourable variance Underlying full year financial position continues favourable, reflecting the lower headcount levels and the progress made against cost improvement plans. Currently forecasting £1044k surplus, which will cover the transformation set up costs of £374k, a risk on CQUIN of £156k and other committed costs of £360k, resulting in a net surplus of £154k. NHS Kirklees has agreed that any surplus generated this financial year can be carried forward into 2011/12. The overall cost improvement plans remain on track with full year target, although shortfalls continue in travel and DN efficiency. Work on-going to determine action plans and timelines demonstrating incremental improvements to meet the target. Operating Framework assumptions have led to a further 0.5% risk to the IBP financial strategy in 11/12. Throughout budget setting we will target a minimum cost efficiency of 5%. Budget setting will form part of Service Development Plans, to ensure that budget holders are planning delivery of service targets, alongside financial targets. Draft budget to be presented to FP&BD. Summary page to be tabled separately. The recommendations to the KCHS Board is to approve the proposed budget actions.


Budget unlikely to be finalised in advance of April month end. JB proposed to mitigate business risk through combination of:Ensuring that the headcount is within the IBP 906 level Either utilising the budget holder submissions for month 1 or utilising month 12 as estimate for month 1 Notifying budget holders that budgets not final and any cost improvement shortfalls will be incorporated into cost centres as unidentified stretch with effect from May/June and discussed with budget holders On-going tracking /monitoring will be in place to identify CIPs as they are identified to reduce the unidentified stretch The KCHS Board RECEIVED, NOTED and APPROVED the proposed recommendation. The KCHS Chair informed the Board that this year everything has to be clear and water tight as the new financial year begins. Contracts have to be in place by the go live date. JPB informed the KCHS Board that he had been assured that the budget for staff will come to KCHS. It was confirmed the total contract budget it is based on head count and activity. ACTION 6 – MC to organise a Board away day morning in May/June to understand the contract thresholds on activity followed by a conference call to discuss contracts going forward with the PCT. Performance report – JB reported all the AHP services have met the 18 week target in the same month for the first time this year, and 12 week target achieved. The podiatry waiting list is now back in line to manage patients within 18 weeks. Early warnings: Dementia screening has slipped slightly in month, but still on target The age 2 MMR immunisation target has dropped 0.2% below target, but the service remains confident that the actions they are taking will achieve target by year end Speech and Language and Paediatric OT have a few patients across the 12-18 waiting list Ethnicity – although in month target has been achieved, concerted effort is required to meet 50% target 5

13-18 Boosters and HPV – sessions planned within the school year which should deliver the required target Targets Not Achieved/Unlikely to be Achieved DN Clinical contact time and contacts per WTE continue below target with unacceptable variation between teams. Action plan is required to address the variation Response times in DN service are still well below 100% target – report by Elaine Sergeant has been produced to update on actions Single personalised care plans at 58% is well below target Immunisation rate for 5 year olds has achieved 95% for the first time, but is unlikely to achieve target by March Vasectomy service is failing both stretch targets as well as 18 week target ACTION 7 – JPB to discuss Vasectomy issues with Caroline Mullins The Integrated Business plan monitor submission to SHA was approved on 1 March 2011. There has been progress on banking arrangements, GL procurement, VAT mitigation, estates and procurement plans. Temporary finance resource in place but financial risk of c£13k per month. Full time recruitment to be done at a later time. Agenda Item 20

Clinical and Operational Lead’s update This item was discussed in the Closed Session under Agenda Item 13.

Agenda Item 21

GP relations and GP Commissioning – Presentation by JPB How will we work with the new consortia’s, Locala needs to develop relationships with GP’s GP sorting themselves out and they will work Change program to locala These two are aligned TCS bit is a policy that needs to be implemented Clear relationship between local and GP commissioning bodies Impact on how we deliver services to GP commissioning bodies Reference groups have been set up one in South and North for Huddersfield and North Consortiums Consortiums could serve notice on single services but not the whole of Locala 6

Reference groups to inform consortiums what we are doing and vice versa to hold discussions. There will also be marketing areas Reference groups are not there to sort Operational issues. ACTION 8 - LC to provide The KCHS Board with a list of Chairs and members of consortiums ACTION 9 – The KCHS Board would like to see strategic information from Commissioning Boards when available. This work needs to be developed further and will be a fundamental part of our responsibility. Operational stuff already exists. Community Care Teams cannot be put in place until DN are freed up from undertaking GP practice work. JPB said the message of where we want to get to will have to be made clear: Plan to develop message consultation with consortia. Whole series of HR and OD consultation round change process Face to face debate with GP New Community Care Teams and how they are structured. The KCHS Board to agree understanding of the two pronged relationship with GP’s doing operational stuff with as much energy if not more than agreeing a contract. JPB is working closely with Locality Managers. ACTION 10 - JPB to bring more details about the 4 points above and working groups. Agenda Item 23

Quality Accounts - Presentation by GR GR reported on her presentation and handed out the work in progress documents Section 1 working documents Section 2 priorities • • • • • • •

First draft version to T7 29 March Addition of 2010-11 data and presentation during April Presented to Board 29 April AM Sent to required stakeholders 29 April PM for 30 day consultation for comments Final version to Board 24 June AM Submitted to DH for publication on NHS Choices 24 June PM Publication by 30 June

The document has to go to Kirklees links, GP Commissioning Consortia. They have 30 days to consider it they can give us with statements what they think of us. 7

They are obliged to include the statements good or bad. They are required to note any changes. Final version to be published by 30th June on NHS choices as a public document. ACTION 11 - MC to bring the finished document back to Board on 28th April 2011 MC will then email the document out to stakeholders. The Final document to come to Board on 24th June then to be submitted to the Department of health the week before final publication date. RF assured the KCHS Board that relationships with Links are good. Agenda Item 25

Proposed Audit Plans - JB The Audit plan comprises of 2 elements, audit of Locala set up – prior to going live and ongoing audit – post set up. Budget implications: £10k Audit costs for Locala set up £33k ongoing costs Funding available is £44k The KCHS Board Recommendations to Review and approve proposed audit plans. Pick up the set up items for the first six months Then second six months scope to move items around The KCHS Board agreed that governance items should be scrutinised for audit For the first half audit will be carried out by the PCT. In the second half will be completed internally. ACTION 12 – Internal audit to be discussed at meeting with Chris Reeves in April. JB to prepare risk plan and send to Chris. ACTION 13 – JB to capture list of audits for future. The KCHS Board approved audit papers.

The KCHSB RECEIVED, AGREED and NOTED the proposed audit plan. Agenda Item 26

Reconciliation IBP to SHA Monitor Submission - JB

The attached reconciliation highlights key changes to IBP financial model approved 15/12/10. These changes result from Operating Framework and KPMG Stress Test. Mitigating actions have been included to offset the 11/12 and 12/13 pressures and ensure the planned surplus meets SHA monitor requirements. The mitigating actions need to be factored into 11/12 budget and clear routes to deliver sufficient efficiencies to maintain adequate contingency 8

Contingency of £400k per original IBP has been eroded by £200k in 11/12 and by £100k in 12/13. Propose to target further efficiency in 11/12 to retain contingency to cover any potential risks. JB informed the KCHS Board that the Mitigating actions Impact of operating framework assumptions is work in progress. After a discussion the KCHS Board RECEIVE and NOTED the reconciliation IBP to SHA Monitor Submission.


Finance, Performance & Business Development - There were no minutes available

Agenda Item 27b

Governance Committee - There were no minutes available.

Agenda Item 27c

Audit Committee - There were no minutes available.

Agenda item 27d

Workforce Committee Minutes Meeting held 7th January 2011

Any Other Business There were no more business items. Date and Time of Next Meeting Thursday 28 April 2011, 13:00 – 14:30 MR 3 Beckside Court